Provider Demographics
NPI:1548603129
Name:BECKE, SUSAN ROBERTA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ROBERTA
Last Name:BECKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1832
Mailing Address - Country:US
Mailing Address - Phone:443-527-4702
Mailing Address - Fax:
Practice Address - Street 1:1780 KENDARBREN DR
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1064
Practice Address - Country:US
Practice Address - Phone:215-489-8760
Practice Address - Fax:215-489-8766
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010696L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist